Dexmedetomidine Versus Remifentanil Monitored Anesthesia Care During Endothelial Keratoplasty: A Retrospective Study

Purpose: Descemet's membrane endothelial keratoplasty (DMEK) is usually performed under topical or locoregional anesthesia; a sedation is often required. Several drugs are administered but undesirable side effects limit the use of each medication. Dexmedetomidine (DEX), a sedative-analgesic, has minimal respiratory depressant effects, and its use in DMEK surgery has not been reported. This study compares the use of DEX versus Remifentanil (REMI) during DMEK. Methods: Retrospective, observational, single-center study. Forty-two patients received sedation with DEX or REMI. Heart rate, blood pressure, oxygen saturation were always recorded during the procedure. The degree of sedation was evaluated using the Ramsay sedation scale; preoperative evaluation of anxiety disorders was carried out with the Hospital Anxiety and Depression Scale, while patients' and surgeon's satisfaction was evaluated using the 7-point Likert-like verbal rating scale. Results: Baseline demographic and clinical characteristics, as well as the baseline anxiety trait were similar for the 2 groups. Patients and surgeons reported higher satisfaction scores with DEX compared to patients receiving REMI ( P < 0.01; P < 0.001). The intraoperative Ramsay score was 3 in 62% of patients in Group DEX and 23% in Group REMI; conversely, it was 2 in 38% of DEX Group and 77% in REMI Group ( P < 0.02). No statistical difference in the hemodynamic and respiratory parameters between the 2 groups was recorded. Conclusions: With similar stability of hemodynamic and respiratory parameters, Dexmedetomedine provided a deeper sedation than REMI without respiratory depression, resulting in better surgical performance in terms of the patients' and the surgeon's satisfaction, thus suggesting a possible role for sedation during DMEK surgery.